Provider Demographics
NPI:1548547789
Name:ANDREA BAKER OPTICAL SERVICES
Entity type:Organization
Organization Name:ANDREA BAKER OPTICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-567-1497
Mailing Address - Street 1:1001 BUCHANAN DR STE 3
Mailing Address - Street 2:
Mailing Address - City:BURNET
Mailing Address - State:TX
Mailing Address - Zip Code:78611-2329
Mailing Address - Country:US
Mailing Address - Phone:512-715-3937
Mailing Address - Fax:512-715-3938
Practice Address - Street 1:1001 BUCHANAN DR STE 3
Practice Address - Street 2:
Practice Address - City:BURNET
Practice Address - State:TX
Practice Address - Zip Code:78611-2329
Practice Address - Country:US
Practice Address - Phone:512-715-3937
Practice Address - Fax:512-715-3938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier